A Case of Rupture of a Pancreaticoduodenal Artery Aneurysm Due to Acute Median Arcuate Ligament Syndrome after Laparoscopic Distal Pancreatectomy

Abstract

A 66-year-old man underwent laparoscopic distal pancreatectomy for a neuroendocrine tumor in the pancreatic tail. On postoperative day (POD) 2, he developed sudden back pain, and enhanced CT revealed a hematoma in the right anterior pararenal space and an anterior inferior pancreaticoduodenal artery aneurysm. Celiac axis stenosis (CAS), which was not observed preoperatively, was also present and was thought to have caused the aneurysm. Selective coil embolization of the anterior pancreaticoduodenal artery was performed via the superior mesenteric artery under abdominal angiography. The patient was discharged on POD 33 without rebleeding. The CAS had disappeared on enhanced CT at 3 months postoperatively. We suspected that the CAS was due to development of acute median arcuate ligament syndrome (AMALS). There have been several reports of AMALS after pancreaticoduodenectomy, but no reports of AMALS after laparoscopic distal pancreatectomy, making this an extremely rare case.